title: A systematic review and thematic synthesis of qualitative studies on maternal emergency transport in low- and middle-income countries.
abstract: BACKGROUND
  Most maternal deaths are preventable with emergency obstetric care; therefore, ensuring access is essential. There is little focused information on emergency transport of pregnant women.
  
  
  OBJECTIVE
  The literature on emergency transport of pregnant women in low- and middle-income countries (LMICs) was systematically reviewed and synthesized to explore current practices, barriers, and facilitators for transport utilization.
  
  
  METHODS
  MEDLINE, EMBASE, BNI, Cochrane Library, CINAHL, African Index Medicus, ASSIA, QUALIDATA, RHL, and Science Citation Index (inception to April 2012) were searched without language restriction.
  
  
  METHODS
  Studies using qualitative methodology and reporting on emergency transportation in LMICs were included.
  
  
  METHODS
  Thematic framework and synthesis through examination and translation of common elements were used to analyze and synthesize the data.
  
  
  RESULTS
  Twenty-nine articles were included. Eight major themes were identified: time for transport; transport options; geography; local support; autonomy; culture; finance; and ergonomics. Key issues were transport availability; transport speed; terrain; meteorology; support; dependence for decision making; cultural issues; cost; and lack of safe, comfortable positioning during transport.
  
  
  CONCLUSIONS
  Themes should be appreciated within local contexts to illuminate barriers and facilitators. Potential solutions include motorcycle ambulance programs, collaboration with taxi services, community education, subsidies, and vehicle maintenance.
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Amie
authors.initials: A
authors.lastname: Wilson
authors.forename: Sarah
authors.initials: S
authors.lastname: Hillman
authors.forename: Mikey
authors.initials: M
authors.lastname: Rosato
authors.forename: John
authors.initials: J
authors.lastname: Skelton
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.forename: Julia
authors.initials: J
authors.lastname: Hussein
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D000552:Ambulances; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*
keywords: Access; Ambulance; Emergency; Obstetric transport; Referral